Healthcare Provider Details

I. General information

NPI: 1558439935
Provider Name (Legal Business Name): DAVID PATRICK GENNIS PSY.D., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 MACKAY DR
SAN BERNARDINO CA
92408-3230
US

IV. Provider business mailing address

3225 PERCHING BIRD LN
NORTH LAS VEGAS NV
89084-2358
US

V. Phone/Fax

Practice location:
  • Phone: 909-279-3711
  • Fax: 909-267-6087
Mailing address:
  • Phone: 480-268-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46820
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number#01166
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: